Provider Demographics
NPI:1548879844
Name:HOUSTON, ROWENA
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 FACULTY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1207
Mailing Address - Country:US
Mailing Address - Phone:562-213-5835
Mailing Address - Fax:
Practice Address - Street 1:3300 E SOUTH ST STE 206
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4590
Practice Address - Country:US
Practice Address - Phone:562-232-2380
Practice Address - Fax:562-232-2739
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95013616363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology